Introduction

This guidance is aimed at integrated care boards (ICBs) to help them prepare their annual reports, so that the annual reports describe their work with people and communities and how ICBs have discharged their public involvement legal duties. This guidance may also be of interest and use to other organisations who wish to achieve these aims when producing their annual reports, including NHS trusts and foundation trusts.

This guidance replaces previous annual reporting guidance from 2016.

Background

Every ICB has a legal duty to produce an annual report on how it has discharged its functions in the previous financial year.

The minimum contents of the annual report are prescribed by the National Health Service Act 2006 (NHS Act 2006) as amended. Section 14Z58 requires that an annual report must include an explanation as to how an ICB has discharged its legal duties on public involvement and consultation. This guidance aims to assist ICBs in this task.

The annual report also needs to explain how an ICB has discharged a variety of other duties, including duties in relation to improvement in research, reducing inequalities and the triple aim.

NHS England has a similar legal duty under section 13U NHS Act 2006 to produce an annual report each financial year, which must include an assessment of how effectively it discharged its duties under section 13Q as to public involvement and consultation.

ICBs may decide to reflect this guidance in their main annual report or, as several clinical commissioning groups (CCGs) had done, produce a separate report dedicated to their work with people and communities, and provide a brief synopsis of and link to this in their main report.

What the law says

NHS commissioning organisations have a legal duty under the NHS Act 2006 to ‘make arrangements’ to secure that individuals to whom services are being or may be provided and their carers/representatives are involved when commissioning services for NHS patients. For ICBs, this duty is outlined in section 14Z45 of the NHS Act 2006 (and for NHS England the duty is outlined in section 13Q).

To fulfil the public involvement duty, the arrangements must provide for the public to be involved in:

• the planning of services
• the development and consideration of proposals for changes which, if implemented, would have an impact on the manner or range of services, and
• decisions which, when implemented, would have such an impact.

More information about the specific legal duties in relation to working in partnership with people and communities can be found in Annex B of Working in partnership with people and communities: Statutory guidance.

Additionally, section 14Z58 of the Act stipulates that each ICB must produce an annual report and that this annual report must “explain how the integrated care board has discharged its duties under sections 14Z34 to 14Z45 and 14Z49.” ICBs must therefore report on how they have discharged their duty to work in partnership with people and communities each financial year. Each ICB must provide a copy of its annual report to NHS England and make a copy of the report publicly available. They must also consult with their local health and wellbeing board(s) in preparing their annual report.

What makes a good annual report on working in partnership with people and communities?

ICBs will have taken different approaches to the public involvement duty and, likewise, ICBs can take different approaches as to how they meet their annual reporting duty.

Given the wide range of requirements to include in the annual report, one option for an ICB is to include a brief synopsis of how the legal public involvement duty has been discharged in the ICB’s main annual report and then provide a link to a separate publication, which is dedicated to the ICB’s work with people and communities. Previously, CCGs that took this approach to their annual reports found that it gave them the opportunity to demonstrate the full breadth of ways they work with people and communities and involve people in their decision-making.

Whichever approach is taken, it is unlikely that an ICB will be able to capture everything it does in its annual report, but an ICB can highlight key elements of its approach and also reference and link to other resources which highlight good practice happening within the ICB.

An ICB may decide to include links to other public reports available online, websites (including the ICB’s own website and any other relevant sites) and other publications, including those at place and neighbourhood levels. These links should – as far as possible – demonstrate the way the ICB have worked with people and communities and the impact the work has had.

Regardless of the approach taken, the following content should typically be included in an ICB annual report:

Governance and assurance information

ICBs should consider including:

• An overview of the structures and processes that support working with people and communities, including any responsible lead(s) for work with people and communities. ICBs may also wish to provide a link to those structures and processes laid out in their strategy for working in partnership with people and communities.
• How working with people and communities takes place at different levels of relevant organisations, including place-based partnerships and primary care networks.
• A statement of the value that the ICB places on working in partnership with people and communities.
• Reference to the ICB’s progress against arrangements, as set out in its constitution, in relation to working with people and communities (‘discharging their public involvement duty’).

Demonstration of how the ICB’s strategy on working with people and communities is being put into practice

Ways to do this include:

• Reference to the principles laid out in the ICB’s strategy on working with people and communities, and progress so far against these principles.
• Key work that has taken place in partnership with people and communities and examples of approaches taken – this can include work led by the ICB and any other work it has been involved in.
• The outcomes of this work and what impact this has had, including examples of how this work is bringing about positive change. This may be around how services are delivered and/or around how people’s health outcomes have improved (though we acknowledge that for the inaugural ICB reports, the timescale for demonstrating impact is limited).
• How activities were designed to reach specific groups, including protected characteristic groups, and how the voices of people experiencing health inequalities and wider inequalities were listened to.
• How the role of people and communities in governance structures was achieved and how the ICB worked with people in planning, setting priorities, making decisions, reviewing and evaluation.
• Details of any regular communication or feedback mechanisms used to build and maintain an ongoing relationship with people and communities.
• Details of promoting opportunities for people and communities to get involved.

Illustration of how insight and data have been used by the ICB to inform its work with people and communities

The annual report should show how intelligence about people’s needs and experiences was gathered and how this informed decision-making, governance and quality-checking. An ICB may have used a holistic approach to data which it will wish to explain, such as a combination of data from:

• existing NHS data sets, such as the GP Patient Survey, Friends and Family Test, Mental Health Services Data Set etc
• any systems in place to collect new or ongoing data
• other organisations’ research such as by the Care Quality Commission (for example, national patient surveys), local Healthwatch, local authorities and local voluntary, community and social enterprise sector (VCSE) organisations
• case studies and people’s stories
• complaints
• insight from previous work with people and communities, including that undertaken by partner organisations in the ICS.

There may be previous good practice happening in the ICB’s area, from prior to the establishment of the ICB, that the ICB are looking to build upon or spread. If so, the ICB should consider including examples.

Evidence that equality and inclusion principles were considered when working with diverse communities

An ICB annual report should demonstrate how the ICB has proactively reached out to groups who are most often excluded from (or less represented in) health services and involvement opportunities, such as people from inclusion health groups, people with a learning disability and people whose first language is not English.

For example, an ICB should consider how it:

• Celebrates any connections the ICB might have with partner organisations and community leaders, who may be uniquely placed to work with particular groups.
• Includes examples of what the ICB may be doing to encourage inclusive involvement of people and communities who face health inequalities.
• Explains how the ICB may be meeting accessibility principles, for example how the ICB ensures public events (whether online or face-to-face) and information are accessible.
• Shows the difference that working with diverse communities has made to the ICB’s work.

Demonstration of how the ICB has worked with partner organisations

The ICB should consider including:

• Details of partners it works with, for example local VCSE organisations and local Healthwatch. The ICB may have worked in partnership with and/or commissioned a VCSE organisation to undertake work on behalf of the ICB
• Any support the ICB have provided (financial or in kind) to enable these organisations’ work.
• An explanation of how the ICB’s work with partners influenced how the ICB worked with people and communities, how the ICB developed services and how the ICB developed its annual report.
• An indication of where the ICB have worked with partners to design services collaboratively, or times when the ICB have gone to groups to listen and find out what matters to them.

Sharing learning and good practice examples

ICBs should consider and explore:

• what has worked well and how it has changed or is changing lives using tangible examples
• what has gone well in the ICB that can be shared with other ICBs
• what could have gone better and how the ICB plan to do things differently in future.

Communications, social media and marketing

An ICB should consider including:

• detail any communications or campaigns that have supported the ICB’s work with people and communities
• highlight any other work by social media and marketing teams that has supported partnership working.

Future planning

Each ICB should provide an outline of key activity planned for the next financial year. Doing so will help the ICB to continuously improve how the ICB works in partnership with people and communities and how the ICB will incorporate learning and good practice.

Making the annual report accessible and appealing

Annual reports should be presented in an accessible and appealing way for a public audience. ICBs should consider the diverse communication styles and needs of their local people and communities and whether alternative versions – such as easy read or audio – are needed to meet people’s needs. The same approach should be taken to any separate report detailing work done in partnership with people and communities which accompanies the annual report.

ICBs should make the whole annual report people-focused and bring it to life where possible by including stories from people and communities and from staff. ICBs will wish to show how their work makes a positive difference.

Structure, layout and presentation

All annual reports should:

• be kept as succinct as possible (within the limits of what is required) – go for quality rather than quantity of information
• have a clear and logical flow and so that the reader can easily find the information they are looking for
• use headings
• within cost and branding constraints, use meaningful photographs, illustrations and other visuals to break up text
• make key points stand out – through summary boxes, bullet points or numbered lists
• keep sentence and paragraphs short – sentences should generally be shorter than 20 words.

Accessible and inclusive language

ICBs should ensure that they:

• Use active verbs – like ‘we sent invitations’ rather than ‘invitations were sent’.
• Avoid jargon and complex terminology – if you need to use a word that people may not know, make sure you explain what it means. It may be helpful for you to include a glossary.
• Avoid acronyms (‘NHS’ and ‘GP’ are generally an exception) – as above, if you need to use an acronym, make sure to write it out in full the first time you use it.
• Ensure that gender inclusive language is used where possible and appropriate.

Examples of good reporting

At the time of publication, ICBs have not yet produced their first annual reports. Accordingly, we have included examples of excellently presented ICB strategies on working in partnership with people and communities, and good annual reports from provider organisations. They exemplify the principles explained in this chapter.

North Central London ICB

• clear delivery plan for approach to working in partnership with people and communities
• good use of glossary
• best practice examples.

Coventry and Warwickshire ICB

• accessibility
• clear plan for how they will work with people and communities.

Humber and North Yorkshire ICB

• visually engaging
• clearly communicated commitments
• good use of case studies, communicated clearly and simply.

Dorset Healthcare University NHS Foundation Trust

• concrete examples of how working with people and communities has had a positive impact
• people-focussed language
• specific learning from engagement.

Leeds Teaching Hospitals NHS Foundation Trust

• clear examples of positive work with people and communities during COVID-19 pandemic
• examples of working with diverse communities and people experiencing the worst health inequalities.